21 



reason that there may be observed in many cases a progressive lower- 

 ing of the temperature with the approach of a fatal termination, so that 

 at the end the temperature may be little if any above normal. In some 

 fatal cases, however, the temperature remains elevated to the end; or, 

 if it has fallen, rises acutely before death and may continue its ascent 

 for some minutes after. Agonic and post-mortem temperatures of 

 42.5° and 43° C. (108.5° and 109.5° F.) have been observed. During 

 the first days of convalescence the temperature is usually somewhat 

 below normal. 



Pulse. — At the outset the pulse is usually full and bounding, and 

 the number of its beats may register 120 or 125 per minute. As the 

 fever progresses the tension and the rapidity of the pulse diminish. 

 At intervals in the course of the disease the pulse may be distinctly 

 dicrotic. At the close,«in fatal cases, it becomes rapid and feeble; in 

 those terminating favorably the pulse not infrequently falls to 50 and 

 occasionally even less. " It is often stated that slowness is a peculiar 

 characteristic of the pulse in yellow fever, but this is not altogether 

 correct. While, to be sure, the pulse in this disease is not a rapid 

 one, its peculiar character consists in the sluggishness with which it 

 responds to the stimulus of a rise ^n the temperature. This sluggish- 

 ness at times amounts to an actual irresponsiveness which is so marked, 

 early in many cases, that there is witnessed the phenomenon of a sta- 

 tionary or falling pulse rate with a rising temperature, or a falling pulse 

 with a stationary temperature. This is not simply a lack of correlation 

 such as is sometimes observed in typhoid, but an actual divergence 

 between the two. Attention was first called to this phenomenon by 

 Faget, of New Orleans, who considered it pathognomonic. 



Unfortunately this sign is not always present and, when present, it 

 is not always as well defined as could be wished. Its minor mani- 

 festations are occasionally observable in other febrile affections, such 

 as pneumonia, malaria, dengue, and septicemia. 



Respiration. — The number of the respiratory movements is usually 

 not notably increased. The character of the respiration is, in many 

 cases, altered somewhat. Many patients experience a feeling of tho- 

 racic oppression so that at variable intervals their breathing is punctu- 

 ated by a sighing respiration. In the latter stages of some cases 

 hiccough appears; it is always an ominous sign. 



Blood. — The results of blood examination are characterized chiefly 

 by their negative character. Morphologically the cellular elements 

 show no alteration. In uncomplicated cases the number of the red 

 corpuscles and the percentage of hemoglobin are not, as a rule, reduced, 

 but, on the contrary , frequently show an increase above the normal. 

 The number of the white corpuscles is somewhat diminished, and the 

 proportion of the different forms is slightly altered. The chief altera- 

 tion consists in an increase in the percentage of the polymorphonuclear 



